Present on Admission Reminder

Date: November 21, 2025

Attention: Inpatient facilities

Call to action: Texas children’s Health Plan (TCHP) would like to remind providers that Medicaid present on admission (POA) codes are required on claims for the following reasons.

For all inpatient hospital clams that are paid under prospective payment basis methodology. No hospitals are exempt from this POA requirement.
Claims submitted without the POA indicators will be denied.
For each diagnosis on the claim form, and no hospital is exempt from this POA requirement.
Medicare crossover hospital claims must also comply with the Medicaid requirement to include the POA values.
POA is defined as present at the time the order for inpatient admission occurs.
Conditions that develop during an outpatient visit, including emergency department, observation, or outpatient surgery, are considered POA.

Sources: TMHP, Claims Filing, Inpatient Hospital Claims 6.4.2.8.3 and Texas Children’s Health Plan Health Care Claim Institutional Companion Guide.

Here are the codes to reference.

POA Value	Description	Payment
Y	Diagnosis was present at the time of admission.	Payment will be made by Texas Medicaid when a hospital acquired condition (HAC) is present.
N	Diagnosis was not present at the time of admission.	No payment will be made by Texas Medicaid when an HAC is present.
U	Documentation was insufficient.	No payment will be made by Texas Medicaid when an HAC is present.
W	Clinically undetermined.	Payment will be made by Texas Medicaid when an HAC is present.
Blank	Exempt from POA Reporting	Exempt from POA Reporting

A complete list of POA exempt diagnosis codes can be found on the CMS website.

Next step for Providers: Providers are strongly encouraged to follow the guidance outlined here and in the supporting sources.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts